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Saturday, July 17, 2010

Guest Post: Why It’s All Worthwhile (or What Keeps Me Going)

(I am posting this as a followup to Gizabeth’s excellent, thought-provoking “Disillusionment” post. I wrote this anecdote awhile back but decided to post it now, since it illustrates so perfectly what “keeps me going” and why I’m not disillusioned despite all the difficulties we face. - gcs15)

“Make a Joyful Noise unto the Lord”

In October 2007, the ER called me for yet another emergency. A thin, elderly man lay on the stretcher with his anxious wife at his side. “He’s been more and more confused, Doctor. This is just not like him!” she said. Sure enough, on examination, he had no focal deficits, but he was clearly disoriented. No history of trauma, no blood thinners, just chronic treatment for myelodysplasia (which was stable). His CT scan showed the reason for his confusion: a large subdural hematoma extending over the entire right hemisphere of his brain. Yet another elderly patient with a subdural.

I took him to the OR emergently that night. I removed a large window of bone from his skull and opened the tense, bluish dura. A large blood clot lay on top of his angry-looking cortex; once the hemorrhage had been removed, his brain began to gently reexpand. Successful surgery, but how would things go over the next few days? So many irritated, elderly brains begin to seize postop. The mortality rate for subdural hematoma is 50%. This is one reason many budding physicians avoid neurosurgery; we see a lot of terribly sick patients, and a lot of them don’t get back to a functional life.

Back in the ICU, the nurses told me, “We’ve been getting a lot of phone calls about this patient! How did he do?” Evidently, he was a Ph.D., a professor emeritus of fine arts at Bob Jones University, beloved by hundreds of students and alumni around the country. He conducted their orchestra and had been composing all kinds of opera and classical music for more than 50 years. His children was all bright and successful, some of them accomplished vocalists. In short, my patient was a brilliant, artistic man.

His first 2 days postop were encouraging. He began to eat and joke a little. I transferred him to the floor and gave a sigh of relief. That evening, however, the nurses called me. “He’s not looking so good.” When I arrived at the bedside, he was minimally responsive, pale and diaphoretic. A workup, including a CT head, was suggestive of infection. I transferred him back to the ICU and aspirated fluid from his wound; clearly he had developed meningitis. I started him on IV antibiotics and began to really worry.

He was very sick for a long time, but he recovered and actually did very well. I got to know him and his family a little during his illness. They were delightful, cultured people with a great sense of humor. The first time I saw him stand up, I realized he was at least 6’6”! We talked about his passion for music and his love of God, among other things. I told him, “When you are completely recovered, and you are ready to conduct again, let me know. I want to come.” He laughed and promised. Privately, I wasn’t sure that would ever happen, after what his brain had been through.

About 2 months after he left the hospital, he came back to my office. “What do you think about this spot?” he asked, pointing to his head. The wound was infected again. Over the next few weeks, he had 2 more surgeries and IV antibiotics to remove the bone flap, clear the recurrent infection, and implant an artificial custom-made bone flap in the defect. Finally, finally, he was better, this time for good.

The months went by, then a year; no news from him. I thought of him every so often, hoping that his cognitive function was still improving. By this time, he was 78 or 79 years old.

Just before Christmas 2009, my phone rang at home. “Hello, Doctor! Remember me?” Of course I did! “Remember my promise? I am conducting Samson et Dalila in March, and I want to know how many tickets you need.” What a wonderful Christmas present!

So my husband and I took my 12-year-old son with us to my friend’s opera that weekend in March. I can’t remember ever enjoying opera so much. It was stunning. A cast of 200, including 3 nationally acclaimed guest performers, and a wonderful orchestra took a simple Bible story and cast a spell that lasted 3 hours. As the stars of the show escorted my patient onto the stage at the end for a long standing ovation, the supertitle proclaimed, “This will be the final major performance of his career.” I stood with his family in the audience, hoping my eyes wouldn’t overflow.

I could feel in the thunder of applause the impact he had made on so many of his students, and the love and respect they have for him. I could feel the force of his personality and the persistence that brought him back to his baton at almost 80 years old. And I could hear clearly the Almighty whispering to him, “Well done, good and faithful servant.”

Professor, I was blessed to have played a tiny supporting role. Bravo, and bravo!

About my patient: Dr. Dwight Gustafson was the longest-serving Academic Dean in the history of Bob Jones University. Samson et Dalila took 2 years of intensive preparation and rehearsal; it was the biggest such production done at BJU in the last 20 years. Dr. Gus says of his illness and recovery, “Through it all, I kept saying to everyone, ‘God is good at all times.’” I continue to be inspired by his faith and his example. This is printed with his permission.

34 comments:

This is beautiful. Thank you for putting back into perspective, that " The Patient " is someone's parent,child, friend, mentor, inspiration. I am more often than not, guilty of compartmentalizing people: Bravo indeed.

Thank you for this account concerning Dr. Dwight Gustafson's medical recovery. I have known him ever since I was a freshman at BJU in 1967, and it has been my distinct privilege to have played in numerous performances under his baton. I also played in the "Samson and Delilah" performance that you attended this past spring.

For the record, Dr. Gus has been one of the two or three individuals who have made the greatest difference in my adult life. He is my hero.

I always try to share the little victories we have with KayTar's care, with the doctors who care for her. I want to remind them that the things they do, even the annoying paper pushing tasks, make a big difference in our quality of life.

Yesterday I posted about my disillusionment but what I did not say is that for every moment I feel that way, I am rewarded with the news of one of my patient's weddings or new grandkids or graduation or new jobs. Today I heard from the family of one of my patients. The daughter she suffered through chemo to deliver just went to first grade.

Jeez, GCS15, you've got my eyes all blurry again, but this time it is over triumph and not struggles, which makes it much more wonderful.

What a stellar post. And I'd like to echo anon above - sure there are lots of little disillusionments -we've all got them - but there are times like above that make it all worth it. And to suffer small disillusionments does not make one globally disillusioned.

And you are making my ears burn. You are a freaking female neurosurgeon/mom - there can't be too many of those around. Thanks for the compliment. I am impressed with your storytelling/surgery skills. Heck, I'm impressed with all of us moms in medicine.

Dr Dwight Gustafson - my favorite professor of my whole college career - grad and undergrad. When I underwent brain surgery for a tumor in 1979, I received a letter from him, encouraging me in his kind and gentle way. It strengthened me to know that he was praying for me and that I was more than just a former student. I knew that I had a true friend.

Thanks for sharing this. I was a student in the fine art dept. at BJU in the 80's and later had the privilege of working with him on some productions. He has had a tremendous impact on my life. This post brought tears to my eyes.

I was never in any musical productions while a student at BJU or as a citizen of Greenville for 14 years following graduation, but I benefited from attending many of them. "Dr. Gus" was a beloved presence on campus even among those of us who only enjoyed music, but even beyond the scope of music, his kindness, humility, commitment to excellence, and desire to glorify God impacted many. Thanks for sharing this.

I had the privilege to sit under Dr. Gus' baton from 1990-1994 in various productions at BJU. I also saw him regularly in the various faculty dining rooms I worked in on campus. At one point in my Junior year I went to see him in his office (I wasn't in trouble, but went to him with a suggestion). I was so impressed at how genuine he was. He listened to my proposal, liked it and helped me set it into motion. I was moved that the DEAN of Fine Arts would take time to listen to a student, and be so supportive. It was moments like that when I knew how much the Faculty & Staff cared for us as students as if we were their own kids.

gcs- as you know, I think this is a wonderful, wonderful post that describes so perfectly why we do what we do: for these moments when you know you have made a difference in the life of a person and have impacted their illness experience for the better.

i go to bob jones and i can say truly that there are thousands of people that love him because his faithfulness to God has impacted them. thank you for posting this...it brought tears to my eyes and chills up my spine :)may you be faithful to God as he is!

This is a wonderful story written by a wonderful doctor. My family has been richly blessed by Dr. Gus's ministry for many years. My parents have had the privilege of calling him their boss. The doctor herself is a wonderful person who we first met in 2008 with my mother in a serious need. She is a wonderful person in the office, the operating room, the hospital room, and then when we see her out and about town. Thanks to her using her God-given skills she has given my mother several more years (hopefully a lot)to enjoy her grandchildren and family. Thank you!!!!

It was my privilege to have Dr. Gus as our choir director at our church when we were between music directors. I learned so much from him in our choir practices - not just about music. He's a faithful servant of the Lord and a wonderful example of striving for excellence.

I was blessed by Dr. Gus' presence in my college life, but I hope that if ever I need a neurosurgeon, this writer will be the one on call. She shows wonderful insight and concern for her patients. Thanks for posting this!

Thank you for this wonderful story. I worked closely with Dr. Gus recording music for the many scores that he did for the film department. He was always a blessing and easy to get along with and wrote wonderful music.

Also thank you so much for the care that you personally took for my wife during her back surgery. You were an unusual doctor and we love you.

Just wonderful! As I am studying for step 2...and sometimes feeling the weight of my own impossible self-imposed standards...whew. I needed a reminder of why I am doing this! To God be the glory. I hope I can help people live a longer, fuller live. Thanks for helping all the people you have helped.

Thank you for posting this and for being a willing tool in the Great Physician's hands. I was a violinist, concertmaster, and orchestra librarian under Dr. Gus. He is a Godly man and has made a huge impact on my life.

Dr. Gus is the epitome of a man who perseveres to the end, all for the glory of God. His presence and insight as conductor will be greatly missed in the orchestra. Thank you for the part you played in his life. Those of us who played under his direction will never forget him!

This man is truly loved by many and was blessed to have you as his doctor. What uplifting there is throughout this post and the comments made about it. It is a good day when I can hear good news and God's Grace instead of the bad news that is reported on a daily basis in the papers. Thank you.

As a fellow woman in medicine (not yet a mother, but hope to be someday) I understand and see and love the sacrifice we give to our patients and the results we glean. For every sad story there are 2 or 3 success stories. As a longtime admirer of Dr Gus, I thank you! We love him so much. I see him every now and again and he is doing wonderfully. Thank you for every minute of sleep lost, moment with your child given up, and frustration spent on helping others. The Lord repay you 100-fold.

Dr. Gustafson has also blessed so many of us in northern Virginia, where his sacred music is performed regularly. It is so well written and heartfelt, yet always tasteful. A cherished memory is when he came to our choir retreat in 2007 as our musical director, teaching us his music and that of others. Just being in his presence was always mentally and spiritually invigorating. We are also repeatedly blessed by all his family.

Dr. Gus loved God and used every ounce and every inch of his being to bring glory to his savior, Jesus Christ. I am so thankful that you got to know him and that you were used of God to extend his life. We will all miss him, but know that the music he wrote and the songs we now sing, will ring in heaven when we all sing together.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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